ARDMS Paediatric Echocardiography (PE) Certification Exam 2026:
Comprehensive Professional Practice Test — Congenital Heart
Defects, Paediatric Cardiac Anatomy, Hemodynamic, Doppler
Imaging, fatal Circulation & Clinical Assessment — 190 Multiple-
Choice Questions with Answers & Detailed Rationales
SECTION 1: NORMAL ANATOMY AND PHYSIOLOGY (Questions 1–20)
Question 1
Which structure separates the right atrium from the left atrium in the normal fetal heart?
A. The interventricular septum
B. The septum primum only
C. The interatrial septum with the foramen ovale
D. The coronary sinus
Correct Answer: C
Explanation: The interatrial septum contains the foramen ovale in fetal life, allowing right-to-
left shunting essential for fetal circulation.
Question 2
In a normal pediatric heart, which valve separates the right ventricle from the pulmonary
artery?
A. Mitral valve
,B. Tricuspid valve
C. Aortic valve
D. Pulmonic valve
Correct Answer: D
Explanation: The pulmonic valve guards the right ventricular outflow tract, preventing
backflow from the pulmonary artery into the right ventricle.
Question 3
What is the normal direction of blood flow through the foramen ovale in a fetus?
A. Left atrium to right atrium
B. Right atrium to left atrium
C. Right ventricle to left ventricle
D. Left ventricle to right ventricle
Correct Answer: B
Explanation: The foramen ovale allows oxygenated blood from the placenta to pass from the
right atrium to the left atrium, bypassing the lungs.
Question 4
Which coronary artery typically supplies the anterior wall of the left ventricle?
A. Right coronary artery
,B. Left circumflex artery
C. Left anterior descending artery
D. Posterior descending artery
Correct Answer: C
Explanation: The left anterior descending artery supplies the anterior wall and anterior
interventricular septum of the left ventricle.
Question 5
The ductus arteriosus connects which two structures in the fetus?
A. Aorta and pulmonary artery
B. Right and left atria
C. Pulmonary vein and left atrium
D. Inferior vena cava and right atrium
Correct Answer: A
Explanation: The ductus arteriosus shunts blood from the pulmonary artery to the
descending aorta, bypassing the non-functional fetal lungs.
Question 6
What is the normal percentage of fetal cardiac output that passes through the foramen
ovale?
A. Approximately 10%
, B. Approximately 25%
C. Approximately 50%
D. Approximately 75%
Correct Answer: B
Explanation: About 25% of fetal cardiac output crosses the foramen ovale, delivering
oxygenated blood preferentially to the brain and heart.
Question 7
Which echocardiographic view best demonstrates the apical four-chamber orientation?
A. Parasternal long-axis view
B. Apical four-chamber view
C. Subcostal short-axis view
D. Suprasternal notch view
Correct Answer: B
Explanation: The apical four-chamber view visualizes all four cardiac chambers
simultaneously, with the apex closest to the transducer.
Question 8
In the parasternal long-axis view, which structure is located most anteriorly?
A. Left atrium
Comprehensive Professional Practice Test — Congenital Heart
Defects, Paediatric Cardiac Anatomy, Hemodynamic, Doppler
Imaging, fatal Circulation & Clinical Assessment — 190 Multiple-
Choice Questions with Answers & Detailed Rationales
SECTION 1: NORMAL ANATOMY AND PHYSIOLOGY (Questions 1–20)
Question 1
Which structure separates the right atrium from the left atrium in the normal fetal heart?
A. The interventricular septum
B. The septum primum only
C. The interatrial septum with the foramen ovale
D. The coronary sinus
Correct Answer: C
Explanation: The interatrial septum contains the foramen ovale in fetal life, allowing right-to-
left shunting essential for fetal circulation.
Question 2
In a normal pediatric heart, which valve separates the right ventricle from the pulmonary
artery?
A. Mitral valve
,B. Tricuspid valve
C. Aortic valve
D. Pulmonic valve
Correct Answer: D
Explanation: The pulmonic valve guards the right ventricular outflow tract, preventing
backflow from the pulmonary artery into the right ventricle.
Question 3
What is the normal direction of blood flow through the foramen ovale in a fetus?
A. Left atrium to right atrium
B. Right atrium to left atrium
C. Right ventricle to left ventricle
D. Left ventricle to right ventricle
Correct Answer: B
Explanation: The foramen ovale allows oxygenated blood from the placenta to pass from the
right atrium to the left atrium, bypassing the lungs.
Question 4
Which coronary artery typically supplies the anterior wall of the left ventricle?
A. Right coronary artery
,B. Left circumflex artery
C. Left anterior descending artery
D. Posterior descending artery
Correct Answer: C
Explanation: The left anterior descending artery supplies the anterior wall and anterior
interventricular septum of the left ventricle.
Question 5
The ductus arteriosus connects which two structures in the fetus?
A. Aorta and pulmonary artery
B. Right and left atria
C. Pulmonary vein and left atrium
D. Inferior vena cava and right atrium
Correct Answer: A
Explanation: The ductus arteriosus shunts blood from the pulmonary artery to the
descending aorta, bypassing the non-functional fetal lungs.
Question 6
What is the normal percentage of fetal cardiac output that passes through the foramen
ovale?
A. Approximately 10%
, B. Approximately 25%
C. Approximately 50%
D. Approximately 75%
Correct Answer: B
Explanation: About 25% of fetal cardiac output crosses the foramen ovale, delivering
oxygenated blood preferentially to the brain and heart.
Question 7
Which echocardiographic view best demonstrates the apical four-chamber orientation?
A. Parasternal long-axis view
B. Apical four-chamber view
C. Subcostal short-axis view
D. Suprasternal notch view
Correct Answer: B
Explanation: The apical four-chamber view visualizes all four cardiac chambers
simultaneously, with the apex closest to the transducer.
Question 8
In the parasternal long-axis view, which structure is located most anteriorly?
A. Left atrium
